The ACS motto: What does it really mean?

Editor’s note: The following is an edited version of the Presidential Address that Fred Weber, MD, JD, FACS, delivered at the 63rd annual Clinical Symposium of the New Jersey Chapter of the American College of Surgeons, which took place December 6, 2014.

The American College of Surgeons (ACS) was founded in 1913 to foster the highest ideals in the practice of surgery. The College continues with this mission today, inspiring quality, providing education, maintaining the highest standards in surgery, and thereby providing better outcomes for our patients.

Origins of the ACS seal and motto

Omnibus per artem fidemque prodesse

In establishing the organization, the founders of the ACS sought to develop a logo for the College that would also contain a short sentence or phrase that would express a rule guiding the behavior of the Fellows. In 1915, the first Director of the ACS, John G. Bowman, MD, FACS, urged the Regents and the ACS Secretary, Franklin H. Martin, MD, FACS, to authorize a competition among Chicago, IL, artists to develop the seal for the College. Paul Frederick Volland, who ran a publishing company in Chicago, IL, entered the contest, and his seal containing the Latin phrase, Omnibus per artem fidemque prodesse, was selected.

Translations

So what does omnibus per artem fidemque prodesse mean? What is the literal translation? What does it signify? Why is this motto still important to us today? The traditional translation has been “to serve all with skill and fidelity.” My version is slightly different. To understand the fullinterpretation of the motto, though, it is helpful to consider each Latin word separately.1, 2

Prodesse: Latin places the verb at the end of the sentence, so the reader is held in suspense until the last word. At the end of the motto is prodesse. It is the present infinitive of the verb prosum, meaning to be helpful, to be useful, and to heal. It is related to the Latin verb sum I am, with its infinitive esse. In his Latin grammar class, young Hamlet might have contemplated esse non esse. “To be or not to be.”

I like to translate this word as “to heal” and put it in the beginning of the English version.

Omnibus:Omnibus is the plural of the noun omnis, meaning “all” and is in the dative plural case. In English this form indicates the noun to which something is given. Here it is healing. Interestingly, our word “bus” is derived from this word; the ending -bus signifies transportation for everyone. This word can be seen on New Jersey taxi and bus license plates. Additionally, a power strip is a power bus. With prodesse this is the main thrust of the motto “to heal all.” We are not to discriminate among whom we heal—we treat all comers.

Per: The preposition per means “through,” “by,” or “by means of.” NPOis a standard medical abbreviation for nil per os: nothing by mouth, not even ice chips. Putting this into English is an awkward construction, so the ACS and I translate this as “with.”

-que: The conjunction –que is added to the second word of a construction, substituting for the English “and.” For example, senatus populusque Romanus translates as “equality between the Senate and the citizens of Rome.”

Artem: The art in artem fidemque refers to the art of medicine and surgery. Translators try not to transliterate a word into English. The practice of medicine and surgery requires skill and this is the primary definition of the Latin word. Translating artem as“skill” makes the English flow more effortlessly.

Fidem: The College has traditionally translated fidem as “fidelity,” but, in my opinion, this translation conveys only a partial meaning of the word. The primary definition is “trust,” and I prefer to translate the word as such. Patients put their trust and lives in our hands. We are entrusted with the surgical care of our patients. As surgeons, we carry the burden of the outcome of our procedures.

The Latin flows easily: Omnibus per artem fidemque prodesse. But, as with many translations, the literal English is somewhat awkward: To heal all through the art and fidelity. My translation is “to heal all with skill and trust.” Physicians stand in a long line of healers, dating from the dawn of civilization to the present. Our patients put their trust in us.

Ties to the Hippocratic Oath

Hippocrates lived and practiced on the island of Kos in the third and fourth centuries before the Common Era. He penned his eponymous oath—which we all swear to uphold as physicians—late in his practice. The Hippocratic Oath, with its 253 words, contains the formula for a successful medical and surgical practice. The Affordable Care Act, with its 234,812 words, does not even come close.

I would like to discuss two parts of the Hippocratic Oath as it relates to us, the ACS motto, and the College today.3

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In antiquity, surgeons were not part of the Hippocratic medical community. Surgeons were “practitioners, specialists in this art.” The dorsal lithotomy position is a common placement of a patient. I prefer to call this position the “childbirth position,” recalling the birth of my daughters. It is literally the “stone cut” position. I suspect that the stone being cut is a bladder stone, as this position would give access to the bladder just superior to the pubic ramus. This must have been a truly horrific procedure, such that it is the only operation specifically proscribed in the oath.

We became physicians when we graduated from medical school. We became “practitioners, specialists in this art” when we completed our surgical residency. We are physicians first and specialists second.

In purity and holiness I will guard my life and my art.

Here, the oath emphasizes the high calling of the healing art.

The physician’s life should be one of restraint from wrongdoing, which will reflect positively on the art of medicine and surgery. The trust patients place in us produces a burden that we carry as surgeons and physicians. This burden is the worry we have when we start an operation, when we have a patient with a complication, when we have to deal with the death of a patient. The ACS unites the surgical community with the healing art through its high standards. We are both physicians and surgeons, aspiring to the highest standard of our practice.

The surgeon’s burden

The Doctor, by Sir Luke Fildes

The painting by Sir Luke Fildes, titled The Doctor, exemplifies the trust our patients place in us (see image, right). Sir Henry Tate commissioned the painting in 1890. The artist was left to his own discretion in choosing the subject matter. Mr. Fildes chose to recall a personal tragedy of his own—the death of his first son, Philip, who died at one year old in his Kensington home in 1877. Mr. Fildes’ surviving son wrote a biography of the artist in which he stated, “The character and bearing of their doctor throughout the time of their anxiety made a deep impression on my parents.”4 When viewing the painting, one notes the anguish of the wife, the stoicism and trust of the husband, the sick child arranged on two chairs, and what I call the “burden” upon the physician caring for the life of the couple’s precious daughter. In this pre-antibiotic era, one could only hope for the dawn to break, the crisis to pass, and for the recovery of the child.

Four days before my graduation from New Jersey Medical School, Newark, an elderly woman knocked at my apartment door. She was a retired physician, and wanted to give me her framed print of this painting. She had watched me for four years, studying in my ground floor studio, and wanted me to have it as it had been with her throughout her practice. Five days after graduation, a massive heart attack claimed her life. In her memory, I have carried The Doctor with me over the last 40 years.

This painting links the motto of the ACS with the trust our patients place in us and the skill we possess as surgeons. Membership in the College and the letters “FACS” that follow our names guarantee that the public can be sure of this trust and skill.